Knowledge, attitude, behaviour and practices (KABP) of the community and resultant IEC leading to behaviour change about dengue in Jodhpur City, RajasthanNivedita July-September 2016, 53(3):279-282PMID:27681552

Background & objectives: In recent years dengue has been witnessed as an emerging public health problem. Therefore, the present study was undertaken in order to assess the knowledge, attitude, behaviour and practices (KABP) adopted by the society for its control and prevention. The changes in behaviour of community after imparting health education were also recorded to determine the effectiveness of information, education and communication (IEC) for dengue prevention and control in Jodhpur City of Rajasthan, India.
Methods: A threefold study was conducted in Jodhpur City regarding KABP about dengue fever amongst the community. Out of 106 cases of dengue reported from Jodhpur City in the year 2008, only 20 households (HHs) could be located. Therefore, nine HHs around one dengue positive household were selected so as to cover the sample size of 200 HHs for eliciting information through structured recorded interview-schedule. Health education as provided through audiovisuals and group discussion etc. and resultant change in KABP was recorded again through interview of respondents from 100 households.
Results: Prevention from dengue mosquito bites through mats and liquid vaporizer was known to 32 and 22% HHs respectively. Inhabitants of 87% HHs preferred to visit private health facility, 85% of HHs were not aware about the symptoms of dengue, while74% HHs stated that dengue mosquito breeds in dirty water. Awareness about source of mosquito breeding and source reduction was found to be very poor, i.e. 3 and 13% which improved to 78 and 88% respectively after undertaking IEC activities.
Interpretation & conclusion: Being urban area, the economic condition and education level were somewhat similar and satisfactory in Jodhpur City. IEC resulted in significant improvement in knowledge about transmission, breeding habitats of mosquito transmitting dengue, source reduction and health treatment seeking behaviour at government facility. Through such mass awareness programmes in the communities, desired results in prevention and control of dengue transmission can be achieved.

Vector-borne diseases particularly those transmitted by mosquitoes like Dengue are among the leading causes of mortality and morbidity in human population. There are no effective vaccines or treatment against dengue fever till date and the control methods are limited. So, new approaches are urgently in need to reverse these trends. Vector control is currently the primary intervention tool. Strategies that reduce or block pathogen transmission by mosquitoes have been proposed as a means of augmenting current control measures to reduce the growing burden of vector-borne diseases. Wolbachia an endosymbiont of arthropod vectors is being explored as a novel ecofriendly control strategy. Studies in Drosophila have shown that Wolbachia can confer resistance to diverse RNA viruses and protect flies from virus-induced mortality. This review was focused on biology of the Wolbachia and its implication as a control measure for arboviral diseases mainly Dengue and Chikungunya.

Genetic characterization and molecular phylogeny of Aedes albopictus (Skuse) species from Sonitpur district of Assam, India based on COI and ITS1 genesMomi Das, Manuj K Das, Prafulla DuttaJuly-September 2016, 53(3):240-247PMID:27681547

Background & objectives: Aedes albopictus (Skuse) is one of the major vectors of dengue which is an emerging threat in Northeast part of India. The morphological characterisation of mosquitoes is time consuming and lacks accuracy for distinguishing closely related species. Hence, molecular methods of mosquito identification, genetic diversity and molecular phylogeny have gained increased importance. This study was aimed to identify and characterize the most abundant species of Aedes vectors collected from different breeding spots in Assam, Northeast India employing molecular as well as bioinformatics tools.
Methods: Ae. albopictus species was genetically characterized with internal transcribed spacer1 (ITS1) and cytochrome c oxidase subunit I (COI) genes and sequence analysis was carried out following molecular methods like PCR amplification, DNA sequencing and multiple sequence analysis. Maximum likelihood molecular phylogeny was reconstructed to define the evolutionary relationship among studied isolates and isolates from other parts of Southeast Asia.
Results: Molecular study revealed that all five subject specimens belonged to Ae. albopictus species as per both ITS1 and COI genes. Maximum likelihood tree based on ITS1 and COI genes showed that isolates were distinctly grouped into separate clusters. Almost similar pattern of amino acid frequencies in COI gene was found amongst the five studied isolates. However, amino acid frequency in ITS1 gene was found to be dissimilar, indicating polymorphisms in this gene, among the isolates.
Interpretation & conclusion: This is the first report among the Northeastern states of India describing the genetic make-up of Ae. albopictus species by virtue of highly conserved mitochondrial (mt) DNA and ribosomal (r) DNA gene sequences. This study also illustrates that the sequence diversity of these two genes in this mosquito species differs geographically which differentiate a population and brings unique identity.

Role of An. culicifacies as a vector of malaria in changing ecological scenario of Northeastern states of IndiaNasreen Akhtar, BN Nagpal, Neera Kapoor, Aruna Srivastava, Neena ValechaJuly-September 2016, 53(3):264-271PMID:27681550

Background & objectives: Malaria has become endemic and subject of concern in most part of the India especially Northeastern states of India. Surveys before 2000 revealed that Anopheles minimus was major vector responsible for transmission of malaria in this region followed by An. dirus and An. fluviatilis. However, recent studies indicate replacement of An. minimus vector by An. culicifacies due to different ecological changes and change in landuse pattern etc. The objective of present study was to explore the vectorial role of An. culicifacies in transmission of malaria in four malaria endemic states, viz. Assam, Meghalaya, Manipur and Sikkim of India.
Methods: The seven surveys were conducted in 176 selected villages belonging to eight districts of the four states in both pre-monsoon (March-April) and post-monsoon (September-October) seasons from 2010 to 2013. However, in 2011 surveys could not be carried out due to public inconvenience in pre-monsoon season. For vectorial role of all vector species collected, ELISA and PCR were assayed.
Results: A total of 19,173 specimens belonging to 30 anopheline species were collected, out of which 4315 belonged to four established vector species. In total, 4183 specimens were processed through ELISA, out of which 236 specimens were found positive for circumsporozoite (CS) protein. Further, infectivity was confirmed by PCR in 35 samples, of which 12 samples were found positive for Plasmodium falciparum and three for P. vivax. Out of 12 Plasmodium falciparum positive samples, nine samples were positive for An. culicifacies, two for An. fluviatilis and one for An. minimus. While out of three Plasmodium vivax positive samples, two samples were positive for An. dirus and one sample was positive for An. culicifacies.
Interpretation & conclusion: Anopheles culicifacies replaced the An. minimus, the vector of malaria in Northeastern states of India, as it was found to be highly infected with malaria parasite as compared to An. minimus by ELISA and PCR analysis, and thus playing a major role in malaria transmission in this region. The ecological changes like deforestation, development of irrigation channels and change in landuse pattern, have helped in evolution of An. culicifacies in the study area. Therefore, modified vector control strategies are required on urgent basis.

Background & objectives: Dengue is a mosquito-borne viral disease, incidences of which have increased rapidly in the past decade. About 400 million new infections are recorded annually worldwide, and 40% of the human population lives in the areas at risk of dengue transmission. In this study, the clinical and laboratory profile of dengue diagnosed patients returning to Poland from tropical areas has been analyzed.
Methods: This is a retrospective study of 65 patients based on clinical symptoms and serological tests conducted in the Department of Tropical Parasitology of Institute of Maritime and Tropical Medicine (IMTM) in Gdynia, Poland during 2010-15. The diagnosis of dengue virus (DENV) infection was based on the detection of specific immunoglobulin M (IgM) and IgA antibodies performed by specific ELISA assays. The samples were considered as positive, if the absorbance was >10% above the cut-off value.
Results: Among 65 persons with dengue selected for the analysis, 59 patients were admitted to the hospital because of clinical symptoms of the disease; the six persons initially asymptomatic were hospitalized due to routine control treatment returning from tropical regions. Patients reported various destinations, purpose and duration of their travels. All of them had returned from dengue endemic regions and were positive for IgM antibodies against DENV. Common clinical symptoms observed were fever (ranging from 38 to 40°C in 43% of patients), weakness, headache and rash. Laboratory tests revealed elevated levels of transaminase activity, leukopenia and thrombocytopenia in 35.3, 24.6 and 20% of patients, respectively.
Interpretation & conclusion: The number of Polish travelers to subtropics and tropics increases every year. As cases of fever and other symptoms appear to be increasingly in Polish people returning from tropical regions of Asia, America and Africa, their screening and management should be taken seriously. The study also suggests that the disease might be more widespread than it was known previously.

Background & objectives: Dengue epidemics have been linked to various climatic and environmental factors. Dengue cases are often found in clusters; identification of these clusters in early phase of epidemic can help in efficient control by implementing suitable public health interventions. In year 2014, Bhopal City in Madhya Pradesh, India witnessed an outbreak of dengue with 729 recorded cases. This study reports spatial and meteorological determinants and, demographic and clinical characteristics of the dengue outbreak in Bhopal City.
Methods: A cross-sectional survey of all confirmed cases reported to District Unit of Integrated Disease Surveillance Programme (IDSP), Bhopal was carried out during June to December 2014. Data pertaining to clinical manifestations, health seeking and expenditure were collected by visiting patient's residence. Geographic locations were recorded through GPS enabled mobile phones. Meteorological data was obtained from Indian Meteorological Department website. Multiple linear regression analysis was used to test influence of meteorological variables on number of cases. Clustering was investigated using average nearest neighbour tool and hot-spot analysis or Getis- Ord Gi*statistic was calculated using ArcMap 10.
Results: The incidence of confirmed dengue as per IDSP reporting was 38/100,000 population (95% CI, 35.2- 40.7), with at least one case reported from 73 (86%) of the total 85 wards. Diurnal temperature variation, relative humidity and rainfall were found to be statistically significant predictors of number of dengue cases on multiple linear regressions. Statistically significant hot-spots and cold-spots among wards were identified according to dengue case density.
Interpretation & conclusion: Seasonal meteorological changes and sustained vector breeding contributed to the dengue epidemic in the post-monsoon period. Cases were found in geographic clusters, and therefore, findings of this study reiterate the importance of spatial analysis for understanding the pace of outbreak and identification of hot-spots.

Background & objectives: In Ethiopia, nearly 10 million insecticide-treated bednets (ITNs) were distributed between 2004 and 2005; which touched 56 million in 2012. The study was aimed to determine the impact of these bednets on malaria prevalence, in Yaso district of Benishangul-Gumuz region, western Ethiopia.
Methods: A cross-sectional study was conducted during the peak malaria transmission season (October-November, 2014) in the Yaso district, Benishangul-Gumuz region. Data on demographic variables, ITN ownership and malaria infection rates were collected using structured questionnaires and blood film tests and analyzed using SAS for windows software. The probability of getting infected (questionnaire and the blood film results) was regressed against groups of explanatory variables, like age, sex, bednet use etc. using multiple logistic regressions.
Results: The results revealed that about 40% of the study subjects (384) were positive for Plasmodium falciparum; while P. vivax, P. falciparum and mixed infections accounted for 74.5% of the study subjects. All the 384 study subjects possessed insecticide-treated bednets; 50.5% possessed one, 39.3% two and 10.2% more than two. According to the logistic regression, there was significant association between illness due to malaria and at least one of the explanatory variables (χ26= 271.9, p<0.0001). For all Plasmodium species, education level, and age appeared to be significant beneficial factors (OR<1 and negative β-values). Occupation was a significant risk factor. Proper ITN utilization improved with increasing educational status.
Interpretation & conclusion: Schools may be appropriate for creating awareness and distribution of ITN instead of the current mass campaign, which is less effective. Efforts of stakeholders (schools, community health workers, and the government) should be integrated.

Background & objectives: Under certain ecological circumstances, pathogens are able to rapidly adapt to new vectors. The great capacity of Plasmodium spp. to adapt to new anopheline mosquito vectors on different continents and the continuous ecological changes attributed to humans might promote their adaptation to culicine vectors, which are known to infect humans. Based on our current knowledge, it is difficult to predict whether such adaptations will occur. This study was aimed to determine the infection susceptibility of Anopheles sinensis, Culex tritaeniorhynchus and Cx. pipiens pallens to Plasmodium vivax in Shandong Province of China.
Methods: The susceptibility of the three predominant species of mosquitoes -An. sinensis, Cx. tritaeniorhynchus and Cx. pipiens pallens in Shandong Province was compared with a direct membrane feeding assay with 15 batches of Shandong strain mono-infected gametocyte-containing blood collected from Plasmodium vivax-infected patients. Infectivity was measured by dissecting the midguts and salivary glands of the mosquitoes. The presence of oocysts and sporozoites was determined by microscopy at 6 and 22 days post-blood feeding.
Results: From the 15 batches of mosquitoes that were fed infected blood, oocysts and sporozoites were detected only in 7th, 13th and 15th batches of infection for An. sinensis, and no oocysts or sporozoites were detected in Cx. tritaeniorhynchus or Cx. pipiens pallens. The positive rate of An. sinensis infection was 21.2, 13 and 36.3% in the three batches of mosquitoes, with an average infection rate of 23.5%.
Interpretation & conclusion: The susceptibility of An. sinensis to P. vivax was very high in Shandong Province. Cx. tritaeniorhynchus and Cx. pipiens pallens failed to exhibit susceptibility to P. vivax.

Background & objectives: Lymphatic filariasis (LF) is a major public health problem in India. The objective of the study was to assess the impact of socioeconomic conditions on LF in Chittoor district of Andhra Pradesh, India.
Methods: A survey was carried out from 2004 to 2007 during which, an epidemiological and socioeconomic data were collected and analysed. The microfilaria (mf) positive samples were taken as cases and matched with control group by sex and age (1:1) for case-control study. Bivariate and multivariate logistic regression was used to identify the potential risk factors for filariasis. Using principal component analysis (PCA), a socioeconomic index was developed and the data/scores were classified into low, medium and high categories.
Results: In total 5,133 blood smears were collected, of which 77 samples were found positive for microfilaria (1.52%). Multivariate analysis showed that the risk of filariasis was higher in groups of people with income < ₹1000 per month [OR = 2.752 (95%CI, 0.435-17.429)]; ₹ 1000-3000 per month [3.079 (0.923-0.275)]; people living in tiled house structure [1.641 (0.534-5.048)], with kutcha (uncemented) drainage system [19.427 (2.985- 126.410)], respondents who did not implemented mosquito avoidance measures [1.737 (0.563-5.358)]; and in people who were not aware about prevention and control of filariasis [1.042 (0.368-2.956)]. PCA showed that respondents with low (41.6%) and medium (33.8%) socioeconomic status are more prone to filariasis (p=0.036).
Interpretation & conclusion: The cross sectional study showed that the population with low and medium socioeconomic status are at higher risk of filariasis. The identified socioeconomic risk factors can be used as a guideline for improving the conditions for effective management of filariasis.

Leishmaniasis is a disease caused by an obligate intracellular protozoan that affects animals and human. Transmission is zoonotic and/or anthroponotic through the bite of an infected female sandfly. Control and elimination of visceral leishmaniasis (VL) require proper case detection, identification of reservoir hosts, and launching of effective vector control strategies in endemic areas. The aim of this review was to highlight the challenges in VL control in developing countries. Literatures pertaining to VL burden, diagnosis, prevention and control from the year 1969 to 2014 were systematically reviewed from PubMed, Scopus, Medline and Google scholar sources during July 2015. Poor vector control strategies, limited diagnostic services, drugs, treatments and lack of community awareness are the most important challenges in VL control and elimination especially in endemic areas. Absence of highly sensitive and specific tests, lack of trained man power, and community awareness are the major challenges in VL control. Therefore, proper case diagnosis, community mobilization and launching of effective vector control strategies in endemic areas are vital.

Background & objectives: Leishmaniasis is an endemic parasitic disease reported sporadically throughout Iran. Golestan province is one of the 17 zoonotic cutaneous leishmaniasis (ZCL) foci. In this study, ecoepidemiological characteristics of ZCL were investigated in Gonbad-e Kavus County, Golestan province of Iran.
Methods: This cross-sectional study was carried out in three endemic villages and one ZCL-free village by exploiting a stratified random sampling methodology in 2013. To understand particular time-allocation and activity patterns, sandflies were entrapped twice per month using sticky traps from May to October 2013. Records of daily maximum and minimum temperatures (°C) obtained from the meteorological station were used to calculate accumulated degree days (ADD) for Phlebotomus papatasi sandflies using an online software, viz. degree-day calculator, available from the website of Integrated Pest Management, University of California. The computational ADD and expected stage appearance for P. papatasi sandflies were evaluated along with the phenological events. Human infection indices were investigated in the study areas as well.
Results: In the entomological survey, a total of 13 different sandfly species were identified. Sergentomyia sintoni (66.8%) and P. papatasi (20%) were observed to be the most dominant species. Monthly activity of the different species of sandflies started from early May to mid-October, with two peaks observed in early July and mid- September, and the peak of hourly activity occurred at night (1900-2000 hrs). According to the phenological study, population dynamics of P. papatasi was completely in agreement with ADD required for the various stages of their growth. Epidemiologically, the highest incidence of ZCL was observed in the age group of 30-34 yr (29.4%).
Interpretation & conclusion: Higher incidence of the disease was seen in the northern and the northeastern parts of the province bordered by Turkmenistan. The most effective alternative for controlling the disease in this hypoendemic focus is health education regarding personal protection from infected P. papatasi. The long-term studies are imperative for better understanding and estimation of the factors affecting ZCL transmission in the endemic areas.

Background & objectives: Association between polymorphisms in the natural resistance associated macrophage protein 1 (NRAMP1) gene and susceptibility to cutaneous leishmaniasis (CL) has been demonstrated worldwide; however, the reported results were inconsistent. This study aimed to determine the association of NRAMP1 variants with susceptibility to CL infection and patients' response to treatment in Isfahan province of Iran.
Methods: Peripheral blood samples were collected from 150 patients with CL and 136 healthy controls. The CL patients were treated with intralesional injection of meglumine antimoniate. The polymorphic variants at NRAMP1 (A318V and D543N) were analyzed using PCR-RFLP. The chi-square test and Fisher's exact test were used to compare frequencies of alleles and genotypes of polymorphisms between patient and healthy control populations.
Results: There was a statistically significant difference in the D543N (rs17235409) polymorphism between the CL patients and healthy controls (p=0.008). However, no significant association was detected for A318V (rs201565523) polymorphism between groups (p=0.26). In addition, there was a lack of association between D543N and A318V genotypes with response to treatment (p=0.54 and p=0.31, respectively).
Interpretation & conclusion: The results indicated that genetic variations of D543N (rs17235409) might be associated with susceptibility to CL infection. These data may be used for detection of sensitive individuals and prevention of CL in endemic areas.